Sensitivity to change of the cutaneous electrical perceptual threshold test in longitudinal monitoring of spinal cord injury

Abstract

Study design: Prospective longitudinal experimental study. Objectives: The aim of this study was to assess the sensitivity to change of the electrical perceptual threshold (EPT) test during the longitudinal monitoring of neurological changes in patients with incomplete spinal cord injury (SCI). Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, Buckinghamshire, UK. Methods: Perceptual threshold to 3 Hz cutaneous electrical stimulation was measured in 11 patients with incomplete SCI at selected American Spinal Injuries Association (ASIA) sensory key points on four occasions. The first three measurements were performed within a 5-day period (baseline) and the fourth measurement (follow-up) at least 9 months later. The results were tested for statistical significance and the effect sizes were calculated. Results: There were no significant differences between the EPT results of the three baseline assessments. When the mean baseline and follow-up EPT results were compared, there were no significant differences in EPT values above the sensory level of lesion, but a significant difference (reduction in threshold values) was found at and below the level of SCI, with medium and large effect sizes, respectively. Conclusion: The EPT test showed good sensitivity to change in dermatomes at and directly below the sensory level of the SCI. This makes it a potentially useful quantitative sensory instrument for detecting changes in sensory function during longitudinal monitoring of patients with SCI.

Time-Dependent Discrepancies between Assessments of Sensory Function after Incomplete Cervical Spinal Cord Injury

“…So far, evidence has shown that the EPT examination has good validity in examining sensory function after SCI, 4,25 good intra-and inter-rater reliability in SCI 26 and control 27,28 subjects, and good sensitivity to detect changes in sensory function over time after SCI. 5 Similarly, studies showed that the ISNCSCI sensory examination shows adequate intra-and interrater reliability, good validity in assessing sensory function after SCI, and can detect changes in a longitudinal manner after SCI (for review, see 29 ).…”

“…It has been proposed that the electrical perceptual threshold (EPT) examination, which measures the sensory threshold or minimally detectable electrical stimulus intensity applied to the skin, 3 is a sensitive tool to assess sensory function that can complement the ISNCSCI examination after human SCI. [4][5][6][7][8][9] The ISNCSCI and EPT examinations have both been used to assess persons immediately and at well-defined periods after SCI. Using the ISNCSCI, it was found that most sensory and motor recovery occurs within the first months after cervical SCI, [10][11][12] but some sensorimotor recovery was also detected 1-5 years post-SCI.…”

Discrepancies between clinical assessments of sensory function and electrical perceptual thresholds after incomplete chronic cervical spinal cord injury

“…At present, all studies that used the EPT in participants with SCI detected sensory deficits as compared to healthy controls. The EPT is a reliable exam across examiners and has sufficient sensitivity to assess sensory function across multiple sessions 10 , 13 . So far studies using the EPT involved heterogeneous groups including individuals in the acute and chronic phase of SCI with complete and incomplete injuries at the cervical, thoracic, and lumbar spinal cord.…”

The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries

“…[57][58][59][60] AGEING AND SURVIVAL Together with the Northwest Regional Spinal Injuries Centre, Southport, UK, and in collaboration with Craig Hospital, Englewood, CO, USA, we have undertaken a longitudinal study on Ageing with SCI in order to provide information on health, functional ability and psychosocial wellbeing in persons with long-term spinal cord injury. 61 In 1990, when the study started, all participants had been injured more than 20 years previously.…”